The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of weight control and weight control plus body image therapy for obese men and women.

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive–behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive–behavioral weight control program is effective as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term psychosocial and adaptive outcomes in children with arteriovenous malformations.

Objective: To describe the long-term social-emotional and adaptive functioning of a small sample of children and adolescents with repaired arteriovenous malformations (AVMs). Participants: Five children (11-15 years of age) with AVMs in the cerebellum and frontal, temporal, and parietal lobes. Main Outcome Measures: Vineland Adaptive Behavior Scales, Behavior Assessment System for Children, Parent Stress Inventory, Children's Depression Inventory, Revised Children's Manifest Anxiety Scale, and a clinical interview. Results: Although overall emotional functioning appeared adequate, there were suggestions of defensiveness and areas of worry. Global adaptive functioning was below average for most children, and parents have concerns about their child's socialization. Conclusion: These children are adapting variably, with more positive than negative findings. The results can help guide clinicians to generate effective rehabilitation strategies to improve the quality of life of children with AVMs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial.

Adolescent girls with body dissatisfaction (N = 481, SD = 1.4) were randomized to a dissonance-based thin-ideal internalization reduction program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Dissonance participants showed significantly greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment and lower risk for eating pathology onset through 2- to 3-year follow-up than did assessment-only controls. Dissonance participants showed greater decreases in thin-ideal internalization, body dissatisfaction, and psychosocial impairment than did expressive writing controls. Healthy weight participants showed greater decreases in thin-ideal internalization, body dissatisfaction, negative affect, eating disorder symptoms, and psychosocial impairment; less increases in weight; and lower risk for eating pathology and obesity onset through 2- to 3-year follow-up than did assessment-only controls. Healthy weight participants showed greater decreases in thin-ideal internalization and weight than did expressive writing controls. Dissonance participants showed a 60% reduction in risk for eating pathology onset, and healthy weight participants showed a 61% reduction in risk for eating pathology onset and a 55% reduction in risk for obesity onset relative to assessment-only controls through 3-year follow-up, implying that the effects are clinically important and enduring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term correlated change in personality traits in old age.

The present study examines long-term correlated change in personality traits in old age across a time period of 12 years. Data from the Interdisciplinary Study on Adult Development were used to investigate different aspects of personality change and stability. The sample consisted of 300 adults ranging from 60 to 64 years of age at Time 1. Personality was measured with the NEO Five-Factor Inventory. Longitudinal structural stability, differential stability, change in interindividual differences, mean-level change, and correlated change of the 5 personality traits were examined utilizing structural equation modeling. After having established strict measurement invariance, factor variances in Openness to Experience and Conscientiousness were found to be different across testing occasions, implying variant covariation patterns over time. Stability coefficients were around .70, indicating high but not perfect differential stability. The amount of interindividual differences increased with respect to Openness to Experience and Conscientiousness. Both mean-level change and stability in personality were observed. Eventually, except for Neuroticism, a number of medium effect-sized correlations among changes in personality traits emerged, implying that personality changes share a substantial amount of commonality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of change.

Empirical research on the stages of change has taken a number of tacks over the past 20 years. In this article, we review those published research studies that have directly examined the stages (precontemplation, contemplation, preparation, action, maintenance, and, termination) as they relate to treatment outcome, broadly defined. The cumulative evidence indicates that tailoring the therapy relationship and treatment intervention to the stage of change can enhance outcome, specifically in the percentage of patients completing therapy and in the ultimate success of treatment. Several limitations of this body of research are noted. We conclude by advancing therapeutic practices both for conventional psychotherapy with individual patients and for proactive recruitment of entire populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of relationship and technique in therapeutic change.

This article discusses varying perspectives on the role of technique and the relationship in therapeutic change. The theoretical assumptions underlying the debate are briefly described, as are the positions of humanistic, behavioral, psychodynamic, and experiential orientations. Theory and research that consider the integration of relationship and technique are presented. It is then proposed that there are general principles of therapeutic change that are facilitated by both the relationship and technique. It is suggested that these principles of change should be seen as the active ingredients of therapy, thereby moving the field away from a debate about whether technique or the relationship is more important. Instead, an emphasis on studying general principles of change and the processes by which technique and relationship facilitate these principles is encouraged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between judgments of a communicator's position and extent of opinion change.

3 groups of Ss, college students, were formed: 2 exposed to a communication on juvenile delinquency and a control group that was not. One group read an appeal for the adoption of a punitive policy toward delinquents; the other group read the same basic communication with the addition of a few introductory statements. Both groups then responded to a modification of Form A of the Wang-Thurstone scale of attitude toward the treatment of the criminal. Judgment of the communicator's position was not found to be related to own opinion on the treatment of delinquents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, race, and body weight.

Objective: Stress has been identified as a significant factor in health and in racial/ethnic health disparities. A potential mediator in these relationships is body weight. Design: Cross-sectional and longitudinal relationships between stress, race, and body weight were examined in an ethnically diverse sample of overweight and obese women with Type 2 diabetes (n = 217) enrolled in a behavioral weight loss program. Main Outcome Measures: Stress (Perceived Stress Scale) was assessed at baseline only and body weight (body mass index) was assessed at baseline and 6 months. Results: Stress was not related to baseline body weight. With every 1 unit lower scored on the baseline stress measure, women lost 0.10 kg ± .04 more at 6 months (p     

The assessment of change during the intensive treatment of borderline and schizophrenic young adults.

This study examined change in 90 patients during long-term intensive inpatient treatment. Two types of patients were differentiated: (a) those primarily with anaclitic psychopathology, whose basic preoccupations were with issues of affection, intimacy, and attempts to establish satisfying interpersonal relations; and (b) primarily overideational patients with introjective psychopathology, whose basic preoccupations were with issues of anger, aggression, and self-definition (Blatt, 1974; Blatt & Shichman, 1983). Variables derived from clinical case reports prepared both early on and much later in the treatment process and from independently administered and scored psychological test protocols obtained at these same two times, indicate significant and constructive changes during long-term intensive inpatient treatment. Variables derived from clinical case reports indicated significant improvement in interpersonal relations in both anaclitic and introjective patients; symptom reduction, however, occurred primarily in introjective patients. Variables derived from the independently administered and scored psychological tests support these findings... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Involving Support Partners in Obesity Treatment.

In this study, the authors examined whether the number or success of weight loss partners influences participants' outcomes in behavioral weight loss treatment. Overweight participants (n = 109) assigned to an exercise intensive group in a larger trial were encouraged to invite up to 3 partners to attend treatment. Weight losses at 6, 12, and 18 months were not associated with the number of partners (0-3) but were associated with the weight loss success of the partners. Participants with at least 1 successful partner (weight loss ≥10% at 6 months) lost significantly (p = .004) more weight at 6, 12, and 18 months than those with no successful partners and those without partners. Interclass correlations of weight change between participants and their partner(s) were strong at all time points (ps     

Clinical series in the behavioral treatment of obesity.

This article reviews the seven large scale clinical series reported to date which used behavioral treatments to effect weight loss in obese patients. Treatment completion and weight loss data are compared with those obtained in other treatments and with benchmark data. It is concluded that weight losses in "live-in" clinics are considerable, and surpass those generally reported in the literature. In outpatient clinics, which are more representative of current obesity treatment, weight losses appear similar to those found in other treatments, and provide no evidence for the superiority of behavioral interventions. However, low drop-out rates, lack of negative side effects, and low-risk may still make the behavioral treatment of obesity the treatment of choice in many clinical settings. Criteria for reports of clinical series are described. New directions for treatment and research are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of mild, moderate, and severe obesity in children.

This paper examines treatment alternatives for children and adolescents as a function of degree of obesity. Treatment for mild obesity (20-40% overweight) should be preventive, emphasizing long-term changes in eating and activity patterns with the goal of weight maintenance and relative weight reduction. Short-term behaviour modification programmes, which include parental support, are effective in achieving these goals. Outpatient clinics or schools where social support is available are appropriate treatment settings. More comprehensive behavioural programmes are needed for treating moderate obesity (41-100% overweight). Such programmes include extended treatment periods, depositrefund contracts, direct parental involvement, and increased emphasis on lifestyle exercise. Outpatient clinics and schools remain optimal treatment settings, but more research is needed on camp settings. Radical treatments such as surgery, drugs, and very low calorie diets cannot be recommended for moderate childhood obesity. Severe obesity (> 100% overweight) requires consideration of radical interventions, and evidence to date supports the experimental use of very low calorie diets (protein-sparing modified fasts) together with behaviour modification. Such dietary treatment must be conducted in hospitals under strict medical supervision. Neither drugs nor surgery can be recommended for severe obesity in children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perception of others’ body size influences weight loss and regain for European American but not African American women.

Objective: The authors investigated whether European American (EA) and African American (AA) women took longer to lose weight, and were less likely to maintain weight loss if they perceived others to be overweight. Design: Overweight EA and AA women completed a Figure Rating Scale and the Three-Factor Eating Questionnaire prior to a weight loss intervention. Body composition was assessed by dual energy X-ray absorptiometry prior to and following weight loss. Main Outcome Measures: rate of weight loss, % body fat at follow-up. Results: For EA, but not AA women, perception of others’ body size was inversely associated with rate of weight loss and cognitive restraint, and positively associated with body fat gain following intervention. In linear regression modeling, EA, but not AA, women who perceived others as large, subsequently had greater percent body fat 1 year after weight loss than did those who perceived others as lean, independent of age, baseline body fat, and body size deemed “acceptable.” Inclusion of cognitive restraint in the model weakened this effect. Conclusion: Among EA but not AA women, perception of others’ body size influenced weight loss and maintenance. This effect may have been mediated by cognitive restraint. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Focusing on weight is not the answer to America's obesity epidemic.

Current authors respond to two comments on their article Medicare's Search for Effective Obesity Treatments: Diets Are Not the Answer (see record 2007-04834-008). The two comments state opposing views of the validity and novelty of the articles conclusions. In his comment, Applebaum (see record 2008-03389-008) claimed that our conclusion is "provocative and unproven" (p. 200), whereas Herman, Van Strien, and Polivy (see record 2008-03389-009) generally agreed with our findings but stated that "this conclusion is hardly new" (p. 202). Research on obesity treatment often leads to polarizing views, and our aim was to present a dispassionate analysis of the methodological issues in the long-term studies of diets. We believe we accomplished this goal, and the conclusions we presented were based on this analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Holiday weight management by successful weight losers and normal weight individuals.

This study compared weight control strategies during the winter holidays among successful weight losers (SWL) in the National Weight Control Registry and normal weight individuals (NW) with no history of obesity. SWL (n = 178) had lost a mean of 34.9 kg and had kept ≥13.6 kg off for a mean of 5.9 years. NW (n = 101) had a body mass index of 18.5-24.9 kg/m2. More SWL than NW reported plans to be extremely strict in maintaining their usual dietary routine (27.3% vs. 0%) and exercise routine (59.1% vs. 14.3%) over the holidays. Main effects for group indicated that SWL maintained greater exercise, greater attention to weight and eating, greater stimulus control, and greater dietary restraint, both before and during the holidays. A Group × Time interaction indicated that, over the holidays, attention to weight and eating declined significantly more in SW than in NW. More SWL (38.9%) than NW (16.7%) gained ≥1 kg over the holidays, and this effect persisted 1 month later (28.3% and 10.7%, respectively). SWL worked harder than NW did to manage their weight, but they appeared more vulnerable to weight gain during the holidays. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differential association between change request qualities and resistance, problem resolution, and relationship satisfaction.

Although research supports the negative sequelae of the “demand/withdrawal” pattern, research is scant on the impact of “nondemanding” change requests (e.g., specific, increasing, “we” requests). We hypothesize that such change requests will be associated with less partner withdrawal/resistance, better problem resolution, and greater relationship satisfaction. Seventy-two conversations between couples who were recruited through random digit dialing were coded for change request qualities. Results indicate that wife specific and “we” requests led to less husband resistance, and husband increasing and “we” requests led to less wife resistance. Greater percentages of wife and husband specific and “we” requests were related to better problem resolution in the conversation, and greater percentages of wife specific and “we” requests were related to greater wife satisfaction. Research and clinical implications are detailed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of diet plus exercise on weight change in parents and children.

Obese children (aged 8–12 yrs) and parents from 53 families were randomly assigned to 3 groups: diet, diet plus exercise, and no-treatment control. At 6 mo, parents and children in both treatment groups had equal and significantly better weight change than members of the control group. At 1 yr, however, parents given diet plus exercise showed better weight losses than parents given diet alone. No treatment group differences were found for children after 1 yr. Parent and child weight changes observed during the 1st 6 mo of treatment were highly correlated, but those observed during Months 6–22 were uncorrelated. Discriminant analyses showed that initial relative weight was the best predictor of 12-mo relative weight for both parents and children but that exposure to the exercise program during treatment was a predictor of maintenance of nonobesity. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between body weight concerns and adolescent smoking.

Although a number of factors have been found to predict smoking status among adolescents, few researchers have examined how belief in smoking as a weight-control strategy may be related to smoking in this high-risk population. With the goal of discovering whether belief in smoking as a weight-control strategy predicted smoking status, the present investigation surveyed 659 Black and White high school students. Analyses showed that among regular smokers, 39% of White female and 12% of White male smokers reported using smoking to control their appetite and weight. Although belief in smoking as a weight-control strategy did not predict regular smokers versus never smokers, the weight-belief item reliably separated experimental smokers from regular smokers. The survey also revealed that White female restrained eaters were the most likely to actually use smoking as a weight-control strategy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traitement de l'obésité: Soutenir l'individu dans l'appropriation de sa démarche.

Obesity is a serious and prevalent health problem that has numerous negative consequences (World Health Organisation, 1998). Body image dissatisfaction has been recognised as an important psychosocial correlate of obesity. Confronted with the thin-ideal model promoted by our society, most overweight or obese women are preoccupied with their body and want to lose excess weight in order to reduce the gap between their actual and desired weight. They also strive to attain this thin-ideal but unreachable model. Although, the underpinnings of obesity are quite clear (i.e., a discrepancy between energy intake and energy expenditure) its treatment is far more complicated. Treatments of obesity, relying essentially on reducing calorie intake while increasing physical activity, seem to be effective in terms of initial weight loss but are often ineffective in terms of long-term maintenance. It is important to identify the potential psychosocial factors that might be involved in the explanation of maintenance failure. This article, discusses obesity and reviews the traditional treatments and their efficacy. The article outlines, based on Self-Determination Theory (SDT), a clinical conceptualisation of maintenance failure. Self-determination has been widely used as a theoretical framework for understanding behavioural change. Recently, empirical findings have supported the relevance of SDT in the comprehension of weight problems. Pelletier and his colleagues (2004) have shown that self-determination is negatively associated with the endorsement of sociocultural pressures to be thin, body dissatisfaction and bulimic symptoms. In addition, they demonstrated that women presenting a self-determined regulation of their alimentation (as compared to women whose regulation is not self-determined) are more preoccupied with the quality of their food than with its quantity, perceive themselves as self-efficient in the regulation their alimentation, engage in more healthful eating behaviours and manifest better psychological functioning. Concurrently, some studies have shown that self-determination is linked to treatment adherence, quantity of weight loss and maintenance. These results clearly indicate the importance of relying not only on the intensity of motivation but also on examining the nature of that motivation in order to understand weight loss and maintenance. Moreover, the distinction between intensity and nature of motivation must be taken into account in our clinical explanation of maintenance failures. Furthermore, although autonomy-support is an essential component of SDT, up until now studies on SDT have been conducted in intensive weight loss programs, programs that are not optimizing autonomy-support. This situation shows an important gap between theory and practice. In reference to a new paradigm of weight management (health at every size approach), our article encourages the development of interventions that will promote autonomy-support and suggests a more extensive participation of psychologists in the development and the empirical validation of such interventions. We conclude with some guidelines to promote autonomy-support in weight management interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)